每日一题_2024.06.21

A 78-year-old man presented to primary care clinic with a 5-day history of constipation and flank bulge. On physical examination, scabbed lesions were seen along the T12 dermatome. There was also an outpouching of the left lower abdominal wall without any underlying masses or fascial defects. Computed tomography of the abdomen was notable only for a protrusion of the left lower abdominal wall. What is the diagnosis?

一位78岁男性患者因5天便秘和腹部侧边隆起前往初级保健诊所就诊。体格检查发现T12神经节段沿线有结痂的皮损。左下腹壁也有突出，但无深层肿块或筋膜缺陷。腹部计算机断层扫描仅显示左下腹壁的突出。诊断是什么？

A. Abdominal wall hernia腹壁疝

B. Diastasis recti直肌分离

C. Lower thoracic disc herniation下胸椎间盘突出

D. Postherpetic abdominal pseudohernia带状疱疹后腹壁假性疝

E. Seroma积液

答案解析：

确诊为带状疱疹后腹壁假性疝。这位患者在就诊前8天被诊断为带状疱疹，并已开始服用瓦拉西洛韦。在带状疱疹患者中，如果病毒从其典型的感觉背根神经节位置扩散到腹根的运动轴突，可能会发生运动并发症。腹壁假性疝就是这样一种运动并发症，它是由受影响神经节段的腹壁肌肉麻痹造成的。患者被告知这种状况的预后是有利的。5个月后，患者的皮肤变化、便秘和假性疝都已减轻。

正确答案：D